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Mr. Deputy Speaker: Order. The hon. Gentleman's time is up.
7.53 pm
Dame Jill Knight (Birmingham, Edgbaston): When I know that the House is to debate the health service, I always read what the British Medical Association has to say before I prepare my speech. One can always rely on the BMA to spread alarm and despondency. Sometimes, I think that BMA should stand for Boundless Misery Alliance. The BMA has attacked every Government reform ferociously and has portrayed every advance as a retreat. As generic prescribing, fundholding and trusts have been introduced over the years, the BMA has fought
them tooth and claw. As time passes, the association realises how good are those reforms and its objections gradually peter out. Then the BMA says, "If there is the catastrophe of a Labour Government, we hope to heaven that they will not alter Conservative reforms."
The BMA only grudgingly acknowledges the ever-increasing amount of money allocated to the NHS and the extraordinary advances in expert treatments. Of course those advances are due to the cleverness of medical practitioners, but they also mean that the NHS has to find a great deal more money to fund them.
The leader in this week's British Medical Journal calls for a debate on rationing health care. It states that
I checked three different dictionaries for definitions of rationing in the Library. One was a
Opposition Members should understand that the BMA is blaming them as much as us. The association says that neither party has the guts to debate the most important matter in health care today--rationing.
The British Medical Journal acknowledges that doctors have always judged whether a particular patient should receive certain treatment. There is nothing new about that. Suddenly, it has to be called rationing and there is a big public debate. The leader blows the gaff later. It states:
There might be a case for decreeing that fertility treatment for women over 55, for example, should not be allowed. Others might say that it is madness to spend millions of pounds on aborting babies, then spend further millions of pounds on enabling women who cannot have babies to have them. I can imagine the howls of rage from the BMA and from the medical profession if the House tried to lay down rules on those matters.
The BMJ article does not finish there. It goes on to state:
Let us be clear about what the BMA is asking. I understand the BMA's position if it is suggesting that GPs should not be called out on trivial matters or that ambulances should not be called out--as many are--on very trivial matters when people could manage perfectly well to take themselves to hospital. However, this week's call from the BMA to demand that we have a great national debate on rationing is wrong.
It is right that we ask the public to regard the health service with some sensitivity, to recognise that we should not call out a doctor if one is not needed and that we should not call an ambulance if it is possible to get to hospital without one. That is not what the BMA is saying, and we should be absolutely clear about that.
Moreover, to help us in our deliberations, the BMA produced a paper for this very debate today. It is a parliamentary brief on bureaucracy and patient care. In that paper, the BMA states that there is
The paper speaks of the turmoil in public district health departments because of the Government's initiative to reduce management costs. I point out to Labour Members that they cannot accuse us of doing nothing when the BMA has itself made it clear that we are doing something.
Mr. Richard Burden (Birmingham, Northfield):
I do not know how to follow that speech, Mr. Deputy Speaker. However, I shall take you back almost a year--to 3 July 1995--when there was a debate in the House on the national health service. I made a speech in that debate, in which I told the House about a primary health care centre
I told the House about how that project--which had been promised several years previously and talked about for many years before that--had not yet been started. The first reason was that--as a result of the market mechanism imposed by the Government on the NHS--none of the trusts could decide which of them had the responsibility to build that primary health care centre.
We had also been told by the then regional health authority--the West Midlands regional health authority, which was particularly popular with the Government--that the capital had been made available. However, last year, I was told that there would be a further delay in building the primary health care centre because--although the capital had been earmarked some years before, and the problem of who had the responsibility to co-ordinate its building had been overcome--the project had to be financed through the PFI. I was assured that matters would still be all right. I was assured that all the tenders would be in by last October, a business case would approved, and that matters would be well in train by this year. That is the problem.
The first stone has not been laid in the primary health care centre. As late as last January, I was still being told by the health trust and by managers that the project was on track. However, a couple of weeks ago, it transpired that the health care centre will be delayed yet again. Why is that? It has been discovered that the PFI--which is much vaunted by the Government--cannot produce the goods for it. Two years after the capital was allocated, the project was delayed because of market operation. It was then put through this ridiculous mechanism, the PFI, which did not work in the first place.
I shall quote from a letter that I received from the developers of that site--called Rubery Hollymoor--who put in a bid and have now found that their bid is unacceptable. They said:
The fact is that something that was promised some years ago has still not been built, and it is now in question. I ask the Minister whether he will now guarantee that the finance and capital that was promised all those years ago will be made available. He may say that he cannot answer that question without some notice, but last week in Health questions I asked this Minister--the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam)--that very question. I asked him whether it is fair that local people should be denied facilities that they have been promised because of a scheme that they did not invent or ask for, but which the Government have imposed on them.
I am glad that the Minister is in the Chamber today. In reply to my question last week, he told me:
In his reply, will the Minister for Health tell the House what that scheme and other PFI schemes have cost the NHS in bureaucratic costs, paperwork and preparation? What have they cost the private sector? Will he give a guarantee--no ifs, no buts and no plans--that that primary health care centre, which has been demanded by the people of Longbridge and promised to them, will be built next year? If he cannot give that guarantee, the private finance initiative, in the way that it is operated by the Government, will be shown up for the sham that it really is.
I want to touch on one other area that also concerns primary care--community services. For too long, that has been the Cinderella service of the NHS. Time and again, Ministers tell us that waiting times are coming down. I acknowledge that, in parts of the acute sector, waiting times have come down, but why do Ministers never give all the figures for all the services provided by the NHS? Why are they rather vague when they talk about community services?
In my constituency, a little five-year-old boy called Matthew Kelsall has been on the waiting list in Birmingham for occupational therapy since May 1995. His mother was told that he would probably be seen in July this year. She has now been told--after pressure from me--that an action plan is being drawn up to improve services and to tackle the waiting list. The result of that action plan is that Matthew is not likely to be seen until December. I may not be very good at sums, but I think that that is a rather longer wait than was originally promised.
That is the operation of the market. It is the way that the health service is being treated by the Government. Community services--the services that are less visible and so do not catch the headlines--suffer time and again. When will the Government come clean and admit that they have not properly funded the waiting list initiative? When will they come clean and admit that they have funded it by borrowing against the future and borrowing from general practitioner underspends? There is no continuing commitment to fund the waiting list initiative.
At the end of the waiting list initiative, when waiting lists are, perhaps, down a little more, how will the Government maintain that improvement? Will they put in the necessary money? Is so, where will it come from? Or will they allow waiting lists to rise again? If they do put the money in, will it be taken from other parts of the NHS? Will it once again be dragged away from community services, family health care services and so on? The public have a right to know.
"governments should come clean with the public and lead a debate on how best to ration health care"
and that neither the Government nor the Opposition face the facts. The leader continues:
"Most commentators accept that rationing is inevitable, but the debate keeps returning to this point because the politicians refuse to acknowledge it."
The word "rationing" is totally inappropriate in this context because it conjures up visions of hard-faced bureaucrats producing ration books, tearing out coupons every time someone visits a doctor, dentist, chemist or optometrist and saying, "You can't have an appendectomy, a hip replacement or a baby because you have used all your tickets."
"fixed daily allowance of food served out for man or animal".
That has nothing to do with health care. Chambers dictionary defines rationing as a
"fixed allowance or portion, especially of food".
The Oxford dictionary defines rationing as a
"fixed allowance or individual share of provisions . . . daily allowance of food allotted to each officer or man."
It even mentions a ration of one pound of bread and three quarters of a pound of meat, and refers to an officially limited allowance for civilians in time of war. That has nothing to do with the problems facing health care.
"We use rationing as a summary term to describe the process of choosing between beneficial services. We have adopted this term because it provokes the greatest public controversy."
In other words, it is all about frightening the horses. I wonder whether the BMA wants Government decrees on which patients should receive expensive drugs, whether smokers should receive cancer treatment, whether drinkers should be given liver transplants and whether there should be an age cut-off for any treatment. Surely those must be medical decisions. The BMA is totally on the wrong track. How can such decisions ever be taken by Government, or even by public agreement? The Government cannot decide whether or to what extent a patient might benefit from a particular treatment.
"The British Government likes to suggest that the drive for effectiveness will obviate the need for rationing."
I have never heard one Minister say any such thing in any speech, and I have never seen such a statement in writing.
"a huge duplication of administrative effort",
but it does not describe that duplication. Of much more relevance, the paper states that a scrutiny team's report on administrative overweighting, produced in July, was welcomed by the Government, and its recommendations will be implemented by December this year. Simpler claim forms will be in place by next Monday. The BMA is therefore saying in this briefing paper that the issues that the BMA has raised with the Government on bureaucracy and overmanning have been well addressed.
"You will be aware that the assessment criteria for PFI schemes are constantly changing and without a clear direction many consortia involved in healthcare projects are becoming increasingly frustrated. Our consortium alone have expended approximately £100,000 in abortive costs on this relatively small scheme.
They enclosed a copy of their most recent letter to the trust.
The sad fact is that unless public sector funding can be secured for this project in the very near future, the local community will not have the benefit of the planned facility for several years."
"I do not know the particular scheme to which the hon. Gentleman refers, but I shall look into it. None the less, the PFI is accelerating the process. We are breaking out of the traditional system whereby
26 Jun 1996 : Column 409everybody has to wait for the Treasury--waiting for Godot, one might say. If the scheme is good, provides value for money, and the risk is properly apportioned, it can obtain private sector finance. We are talking about a new era for hospital building in Britain, yet we still do not know what the Opposition think about it."--[Official Report, 18 June 1996; Vol. 279, c. 678.]
I will tell the Minister what I think about it. I am all in favour of trying to attract private finance when it speeds matters up, when it helps and when it is additional. I am not in favour--I do not know anyone who is, apart from Conservative Members--of schemes that delay the process, cost the private sector thousands of pounds and destroy their confidence, or that end up requiring public funds but with question marks over a capital budget that was supposedly already there.
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